N.J. to create bioethics team to help make 'difficult’ choice of which coronavirus patients get a ventilator in case of shortage

New Jersey is creating a bioethics panel to evaluate what would happen if the demand for ventilators needed to help critically ill coronavirus patients exceeds the supply, as is expected, state Health Commissioner Judith Persichilli said Thursday at the daily briefing.

Garden State hospitals have about 2,000 intensive care beds and needs to double that amount, Persichillisaid. It also needs an additional 2,300 ventilators, and has asked the federal government for help in finding them, she said.

The state has enlisted the Medical Society of New Jersey, the state’s largest organization of physicians, to work with retired state epidemiologist Eddy Bresnitz to lead the discussions, Persichilli said.

“The group will discuss the bioethical considerations of life-saving modalities,” Persichilli said during the state’s daily coronavirus media briefing. “It is one of the more difficult issues we are discussing.”

The Medical Society’s own bioethics committee has been around since the landmark right-to-die case more than 40 years ago involving Karen Ann Quinlan, Executive Director Larry Downs said. That group met last week to review ethics policies around the country and assembled a 'decision tree or matrix,’ similar to what medical panels use when they are considering organ transplants.

The Medical Society’s committee shared its research with the Murphy administration, which will be used “to start the dialogue” when the new panel holds its first meeting on Monday, Downs said.

Bresnitz will lead a professional advisory committee “comprised of experts who will provide clinical guidance to the Commissioner and the Department to ensure that we respond appropriately—based on the latest scientific, medical and public health evidence—to this ever-evolving pandemic,” health department spokeswoman Donna Leusner said.

Persichilli and Bresnitz are still finalizing the list of participants, Leusner said.

The panel will provide guidance on issues ranging from how best to distribute personal protection, life-saving equipment like ventilators and access to future experimental treatment and vaccines, Downs said.

“It’s a really good idea to have this committee formed, and it can be a great resource to the governor and the health department,” Downs said.

Arthur Caplan, a professor of Bioethics at New York University Langone Medical Center and the founding director of the Division of Medical Ethics, said he’s gotten calls from hospitals across the country grappling with the same thorny questions as the coronavirus overwhelms the health care system.

“It will not happen everywhere, but in the next week or two, we will see some rationing decisions,” Caplan said.

These discussions trouble people with disabilities who fear “they are not going to be given a chance," Caplan said. The elderly are already nervous, Caplan said, based on comments by Texas Lt. Gov. Dan Patrick earlier this week that they should put the nation’s economy ahead of their risk of getting sick if businesses reopen. People in prison and undocumented immigrants likely believe they won’t be considered at all as they life-and-death decisions are made, he said.

Caplan would advise hospitals to be transparent about their decision-making process, to show the public “we are going to give everyone a chance, within reason."

“How can you save the most lives — that should be the driving criteria,” said Caplan, who serves on Johnson & Johnson’s Compassionate Use Advisory Committee, which decides who receives life-saving treatment in short supply.

Age will be one factor guiding these decisions, but there shouldn’t be an age limit, Caplan said. “If you are 85, you probably have diseases you won’t see in 23-year-olds,” he said. In discussions about organ transplants, “age is a reliable predictor of how well they do," and how long they may live, he said.

As the number of COVID-19 cases explode across the country, every hospital is confronting a shortage of life-saving equipment, including ventilators. In the past, doctors have been able to configure ventilators to serve more than one patient, according to an article by Live Science, citing a 2006 study in the journal Academic Emergency Medicine.

On Thursday, the Society of Critical Care Medicine, the American Association for Respiratory Care, American Society of Anesthesiologists, Anesthesia Patient Safety Foundation, the American Association of Critical‐Care Nurses, and the American College of Chest Physicians issued a statement saying sharing ventilators was not safe.

“The above‐named organizations advise clinicians that sharing mechanical ventilators should not be attempted because it cannot be done safely with current equipment," according to the statement.

A ventilator is a machine that helps people breathe by connecting a tube into the mouth, nose or down into the windpipe, according to the American Thoracic Society. The ventilator is also called a respirator or breathing machine.